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Hypertension and mortality in the Golestan Cohort Study: A prospective study of 50 000 adults in Iran

Journal of Human Hypertension volume 30, pages 260–267 (2016)Cite this article

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Abstract

High blood pressure has been the second most important determinant of disease burden in Iran since the 1990s. Despite well-recognized evidence on the association of high blood pressure and mortality in other countries, this relationship has not been fully investigated in the demographic setting of Iran. The current study is the first large-scale longitudinal study of this association in Iran. Briefly, 50 045 subjects between 40 and 75 years of age have been recruited and followed. Blood pressure measurements were carried out at baseline. Causes of death were reported and verified by verbal autopsy throughout the follow-up period. The outcomes of interest were all-cause deaths and deaths due to ischemic heart disease (IHD) or stroke. Cox proportional hazards regression models were used to estimate hazard ratios (HRs). A total of 46 674 subjects free from cardiovascular disease at baseline were analyzed. Absolute mortality rates increased along with increasing systolic or diastolic blood pressure above 120 and 80 mm Hg, respectively. Adjusted HRs (95% confidence intervals) for each 20 mm Hg increase in systolic blood pressure in all age groups were 1.18 (1.13–1.23) for all-cause mortality, 1.21 (1.13–1.31) for deaths due to IHD and 1.50 (1.39–1.63) for deaths due to stroke. Unadjusted and adjusted HRs were higher in younger subjects and decreased with increasing age of the participants. High blood pressure is a serious threat to the health of Iranians. The entire health-care system of Iran should be involved in a comprehensive action plan for controlling blood pressure.

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Acknowledgements

This study was supported in part by the intramural research program of the Division of Cancer Epidemiology and Genetics of the National Cancer Institute, NIH, by the Digestive Disease Research Institute of Tehran University of Medical Sciences (grant No 82–603), by Cancer Research UK (CRUK) and by the International Agency for Research on Cancer. We sincerely thank the Golestan Cohort study staff for their valuable helps. We also thank the study participants for their cooperation and health workers (Behvarz) in the study area for their help.

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Authors and Affiliations

  1. Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

    S G Sepanlou, M Sharafkhah, H Poustchi, M M Malekzadeh, A Etemadi, H Khademi, F Islami, A Pourshams, F Kamangar & R Malekzadeh

  2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA

    A Etemadi, C C Abnet & S M Dawsey

  3. Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA

    F Islami

  4. Departments of Oncology and Public Health and Primary Care, University of Cambridge, Cambridge, UK

    P D Pharoah

  5. International Agency for Research on Cancer, Lyon, France

    P Brennan

  6. The Tisch Cancer Institute, and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    P Boffetta

  7. Endocrinology and Metabolism Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran

    A Esteghamati

  8. Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA

    F Kamangar

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  1. S G Sepanlou
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Correspondence to R Malekzadeh.

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Sepanlou, S., Sharafkhah, M., Poustchi, H. et al. Hypertension and mortality in the Golestan Cohort Study: A prospective study of 50 000 adults in Iran. J Hum Hypertens 30, 260–267 (2016). https://doi.org/10.1038/jhh.2015.57

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